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Application form for seeking information under The Right to ...

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<strong>Application</strong> fee: Rs.10<br />

<strong>Application</strong> <strong><strong>for</strong>m</strong> <strong>for</strong> <strong>seeking</strong> in<strong><strong>for</strong>m</strong>ation <strong>under</strong> <strong>The</strong> <strong>Right</strong> <strong>to</strong> In<strong><strong>for</strong>m</strong>ation Act, 2005<br />

<strong>The</strong> Public In<strong><strong>for</strong>m</strong>ation Officer/<br />

Asstt. Public In<strong><strong>for</strong>m</strong>ation Officer,<br />

New Okhla Industrial Development Authority<br />

Admn Block, Sec<strong>to</strong>r-VI<br />

Noida-201301<br />

Date DD MM YY<br />

Receipt No…………..<br />

Sir,<br />

I hereby request you <strong>to</strong> provide following in<strong><strong>for</strong>m</strong>ation <strong>under</strong> <strong>Right</strong> <strong>to</strong> In<strong><strong>for</strong>m</strong>ation Act, 2005<br />

in respect of NOIDA Authority.<br />

Particulars of in<strong><strong>for</strong>m</strong>ation required (All fields are manda<strong>to</strong>ry):<br />

(i) Subject matter & Description of in<strong><strong>for</strong>m</strong>ation required:<br />

(ii) <strong>The</strong> period <strong>to</strong> which the<br />

in<strong><strong>for</strong>m</strong>ation relates:<br />

From<br />

To<br />

(DD/MM/YY)<br />

(DD/MM/YY)<br />

(iii) Whether in<strong><strong>for</strong>m</strong>ation is required by:<br />

Post (<strong>The</strong> actual postal charges shall be included in additional fees)<br />

□ Ordinary □ Registered □ Speed<br />

In Person<br />

(iv) Please enter any one of the following:<br />

PAN card No<br />

Voter's card No:<br />

Passport No:<br />

Ration card No:<br />

I hereby declare and confirm that I am an Indian citizen and as such I am entitled <strong>to</strong> seek in<strong><strong>for</strong>m</strong>ation <strong>under</strong><br />

RTI Act, 2005. I have attached copy of my PAN card/ Voter's card/ Passport/ Ration card in support of my<br />

citizenship. I shall use this in<strong><strong>for</strong>m</strong>ation <strong>for</strong> my personal purpose only. I assure and con<strong><strong>for</strong>m</strong> that in any case<br />

or/and <strong>under</strong> any circumstances, I shall not ( allow/cause) use/pass on/share/display/keep/ciculate the<br />

in<strong><strong>for</strong>m</strong>ation received, with any person or in any manner which would be detrimental <strong>to</strong>/against the interests<br />

of India. If any in<strong><strong>for</strong>m</strong>ation /declaration turns out <strong>to</strong> be incorrect or false, I shall be responsible and liable<br />

<strong>for</strong> consequences apart from losing right <strong>to</strong> receive in<strong><strong>for</strong>m</strong>ation.<br />

Signature of the applicant<br />

Place:<br />

Date:<br />

Full name of the applicant (Fill in Block letters):<br />

Surname First Name Second Name<br />

Address:<br />

House No./ Bldg. Name<br />

Street Name/Area<br />

City & Pin Code<br />

Telephone<br />

E-mail<br />

Reference:<br />

NOIDA/RTI/<br />

(For Office Use)<br />

Received by:<br />

□ Post □ E-mail<br />

DD MM YY<br />

Sign and Name of receiving officer


(For Office Use Only)<br />

Follow Up Status<br />

<strong>Application</strong> <strong>for</strong>warded <strong>to</strong>:<br />

Name:<br />

Designation:<br />

Signatures of Receiving Officer Time DD MM YY<br />

In<strong><strong>for</strong>m</strong>ation Received on<br />

Time DD MM YY<br />

In<strong><strong>for</strong>m</strong>ation sent<br />

<strong>to</strong> applicant on<br />

1st Reply<br />

(DD/MM/YY)<br />

2 nd Reply<br />

(DD/MM/YY)<br />

3 rd Reply<br />

(DD/MM/YY)<br />

4 th Reply<br />

(DD/MM/YY)<br />

In<strong><strong>for</strong>m</strong>ation has <strong>to</strong> be sent <strong>to</strong> applicant on /be<strong>for</strong>e Date:<br />

DD MM YY<br />

Signatures (when the in<strong><strong>for</strong>m</strong>ation was sent)

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